YOU CAN IMPLEMENT PALLIATIVE CARE

Learn from yesterday Live for today Hope for tomorrow Albert Einstein

Public Health Model Policy Drug availability Education Implementation s i t u a o n o u t c m e s Drug availability Education Implementation WHO model, Stjernsward and Foley

Levels of palliative care Level 1: Primary/ Basic essential or the minimum package Level 2: Secondary/ Intermediary. intermediary services which provide a wide range of care components. Level 3: Tertiary/ Specialist desirable for a specialist palliative care service APCA Standards for Providing Quality Palliative Care Across Africa 2010

Models of palliative care Palliative care integration public health approach health system strengthening demonstration services non governmental and faith based services academic institutions community and family empowerment

Health system strengthening a working health system improves health. delivers services operates at community, local, national levels uses effective organizations and processes engages all sectors reaches priority groups and health issues responds to people’s needs employs appropriate incentives characterized by strong political will and a viable vision. http://www.usaid.gov/our_work/global_health/hs/

Models of palliative care Service delivery inpatient hospice / palliative care unit outpatient clinics and day care outreach clinics / mobile hospice home based care hospital based palliative care teams Wright M. Models of hospice and palliative care in resource poor countries: issues Help the Hospices UK (2003)

IAHPC Essential practices

IAHPC Essential practices

IAHPC Essential practices

Palliative care; an opportunity Professional practise doing experience knowledge feelings expectations assumptions attitudes beliefs values D Fish and C Coles 1998 Leng M. Changing value, challenging practice; IJPC Jan 2011

A tool to help implementation SMART objectives Objectives – things we want to do or change S – Specific M – Measurable A – Achievable R – Realistic T – Timely

1 2 3 4 5 6 Specific Measurable Achievable Realistic Timely

When working as a team I add two more letters P – Person A – Accountable SMART PA That way things are more likely to get done.

The challenge We often get excited when we learn new things We leave a training course full of good ideas We make promises to ourselves to do things differently but nothing changes

The challenge Why does nothing change? environment and systems lack of leadership engagement lack of practical mentorship lack of clinical/work based support lack of team work does not seem relevant ?????

Next steps…. Resources are limited work together be creative integrate with other services / people look for dedicated people ‘fire in the belly’….’heart of compassion’ tap into existing resources persevere

Next steps…. A journey of a thousand miles begins with a single step Confucious Do small things with great love Mother Theresa

These resources are developed as part of the THET multi-country project whose goal is to strengthen and integrate palliative care into national health systems through a public health primary care approach Acknowledgement given to Cairdeas International Palliative Care Trust and MPCU for their preparation and adaptation part of the teaching materials for the Palliative Care Toolkit training with modules as per the Training Manual can be used as basic PC presentations when facilitators are encouraged to adapt and make contextual